A Prospective Randomized Study of Arthroscopic and Microscopic Discectomy in Protruded Lumbar Disc Herniation

Chung, Jae Yoon; Joo, Dae Chang

Abstract

PURPOSE
To obtain reliable clinical data arthroscopic discectomy, the authors compared the treatment results of the arthroscopic discectomy (AS) with microscopic discectomy (MS) only in the protruded type of lumbar disc herniations. MATERIAL AND METHODS: Each arthroscopic and microscopic discectomy groups consisted of 39 patients who were operated between May 1993 and October 1997. Minimum follow-up period was 12 months. Method of operation was selected at random and was performed under local infiltration anesthesia in all cases. Clinical and radiological results were evaluated by same protocol before and at one, three, six and 12 months after operation. The herniations of the AS group affected L4-5 in 35 patients and L5-S1 in 4 patients, and of MS group affected L4-5 in 31 patients and L5-S1 in 8 patients. Age, sex and level showed no statistical differences in both groups.
RESULTS
Average admission periods were 2.8 days in AS and 4.8 days in MS group. The overall objective clinical result was satisfactory in 92% and 90% respectively. At L4-5 level, it was 97% and 87%, while 50% and 100% at L5-S1. In accordance with the direction of protrusion, midline type showed 100% and 83%, while posterolateral type showed 91% in both group respectively. Disc space height was changed in AS group from 12.2mm preoperatively to 11.2mm (8.3%) postoperatively, and in MS group, from 12.4mm to 10.9mm (16.9%) (p<0.05) .
CONCLUSION
From the clinical and radiological results, it was concluded that although overall objective and subjective clinical results were similarly satisfactory in both methods, the clinical result of AS was better in L4-5 level, while that of MS were much better in L5-S1. Radiologically, narrowing of disc space height after AS were significantly less than in MS. So, arthroscopic discectomy is more recommended in the protruded type of lumbar disc herniation at L4-5 level than microscopic discectomy.